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Central Wisconsin High School Leadership Application

A total of 40-45 students will be selected into the program. Students will be notified by August 1 of their acceptance. After the student is notified, the tuition payment will be requested to secure the student’s place in the program. The information provided below will be used solely for program evaluation and program eligibility purposes. It will be kept confidential.

I. Personal Data

First Name:

Last Name:

Birth Date (mm/dd/yyyy):

Gender:

Male
Female
Other:

T-shirt Size:

Small
Medium
Large
X-Large

Race/Ethnicity:

White
Hispanic or Latino
Black or African American
Native American or American Indian
Asian / Pacific Islander/Hmong/Laotian
Other:

What is your current Grade Point Average (GPA)?

Student's Mobile Phone:

Street Address:

City:

Zip:

Student's Email Address:

Year of Graduation

2026
2027
2028

II. Student Primary Parent or Guardian Contact Information

First Name of Primary Parent or Guardian:

Last Name of Primary Parent or Guardian:

Relationship to Student:

Mother
Father
Guardian
Other:

Street Address

City:

Zip:

Mobile Phone:

Work Phone Number:

Email:

III. Essay Questions - Students please respond to the following questions:

If you are selected into the leadership program, how will you use the leadership skills you learn to serve your community?

List below any clubs or organizations that you belong to in school, church, or the community:

Please share why you may not have not been as active in community, civic, or school activities as you would like to be:

Has your primary parent listed above earned a bachelor’s degree from a four-year university or college?

Yes
No

Has your other parent earned a bachelor’s degree from a four-year university or college?

Yes
No

IV. Scholarship Opportunity

Scholarships are available to students who may find it difficult to pay the $275 participation fee due to financial difficulties. If you are interested in being considered for a scholarship, please complete the information below. If you are not interested in applying for a scholarship, please skip the next two questions. All approved scholarship recipients will be required to pay a fee of $50.

If you would like to be considered for a scholarship to attend this program, please share in few sentences how the scholarship would be helpful.

Does your family qualify for or receive free or reduced priced meals at school?

Yes
No

V. Student Commitment:

I understand the purpose of the Central Wisconsin High School Leadership program and if I am selected, will devote the time and energy necessary to complete the program. Even though emergencies do arise, I understand any participant missing more than one session, for whatever reason, will be asked to withdraw from the program and no portion of the tuition will be refunded. Please check yes if you agree.

Yes, I understand the above commitment and agree to this by submitting this application.